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Undeleted > Cardio Exam 4 > Flashcards

Cardio Exam 4 Flashcards

1
Q

Assc diseases with congenital valvular disease

A

Patent ductus arteriosus

aortic coarctation

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2
Q

Path of MVP

A

expansion of spongiosa

disruption of fibrosa

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3
Q

Risk of mitral annular calcification

A

thrombi/infective carditis formation

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4
Q

Subacute infective endocarditis with colon cancer

A

strep bovis

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5
Q

Prosthetic valve early infective endocarditis

A

staph epidermidis

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6
Q

Peripheral manifestations of infective endocarditis

A 
Roth spots
Osler nodes
Janeway lesions
splinter hemorrhages
mycotic aneurysm
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7
Q

IV drug users acute bacterial endocarditis location and bug

A

R side of heart

S. aureus

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8
Q

Assc with nonbacterial thrombotic endocarditis

A

adenocarcinoma-> hypercoaguable state

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9
Q

Libman Sacks endocarditis cause and histo

A

SLE

esoinophilic/granular verrucae

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10
Q

Bugs to tx with aminoglycosides

A 
pseudomonas aeruginosa
enterobacteriaceae
gram (-) with gentamicin due to + charge
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11
Q

Most common subacute IE bug

A

viridans strept

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12
Q

Abiotrophia Granulicatella growth and assc

A

needs L-cysteine or Vit B6
URT/urogenital/GI infection
prone to systemic embolization

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13
Q

IE with negative blood cultures

A

HACEK bugs

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14
Q

Coxsackie virus with myocarditis

A

cleaves dystrophin with viral protease 2A

decreases contractility

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15
Q

Parvovirus B19 with myocarditis

A 
replicates in endothelial cells
slap cheek (5th disease)
maculopapular rash
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16
Q

Corynebacterium diptheriae with myocarditis

A

toxins A and B, B allows entry, A inhibits EF2

Also conjunctivitis/pharyngeal membrane and bull neck

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17
Q

Borrelia burgdorferi with myocarditis

A

tick is vector

damage from macrophages killing spirochetes

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18
Q

Trypanosoma cruzi with myocarditis

A

kissing bugs (reduviids) are vector
rash/edema around eye (Romano’s sign)
T cell lysis of myocytes where it replicates

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19
Q

X-linked dilated cardiomyopathy gene

A

dystrophin gene mutation

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20
Q

Arrhythmogenic RV cardiomyopathy path and gene

A 
severely thinned (with fat) RV
defect of cell adhesion proteins in desomosomes
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21
Q

Naxos syndrome

A

arrhythmogenic RV cardiomyopathy
kyperkeratosis
plakoglobin gene mutation

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22
Q

Hypertrophic cardiomyopathy path and gene

A

haphard disarray of myocytes

sarcomeric genes

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23
Q

Endomyocardial fibrosis assc

A

children/young adults in tropical areas

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24
Q

Loeffler endomyocarditis

A

endomyocardial fibrosis

lg mural thrombi with eosinophilic inflitrate

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25
Q

Amyloidosis dx and histo

A

stains with congo red (fluoresces green)

beta sheet folding of proteins

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26
Q

Senile cardiac amyloidosis deposition

A

transthyretin

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27
Q

Impact of hemachromatosis on heart

A

iron deposition causes ROS to damage myocardium

results in systolic dysfunction

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28
Q

Atrial myxoma

A

in adults

ball valve obstruction

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29
Q

Types of myocarditis (4)

A

lymphocytic
hypersensitivity (drug induced, increased eosinphils)
giant cell (rapid and fatal)
Chagas disease

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30
Q

Rhabdomyoma histo and demographic

A

in children

spider cells

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31
Q

Most common type of cardiac cancer

A

metastasis:
lungs/breast
melanoma
lymphoma/leukemia

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32
Q

Impact of carcinoid syndrome on heart

A

increased vasoactive amines (5HT) cause plaques on R sided valves

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33
Q

Phospholamban and role in increased HR

A

normally blocks SERCA (Ca2+ reuptake)
phosphorylated by PKA-> allows faster reuptake
with increased HR, need faster relaxation
done by phosphorylating phospholamban

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34
Q

Causes of paradoxical S2 splitting

A

During expiration, aortic closes later
LBBB
aortic stenosis
anything slowing L ventricular emptying

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35
Q

Cause of fixed S2 splitting

A

atrial septal defect hallmark

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36
Q

Chronic mitral regurg sound

A

holosystolic murmur

louder with squat/isometric contraction

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37
Q

Acute mitral regurg sound

A

early systolic decrescendo

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38
Q

Mitral valve prolapse sound

A

midsystolic click

late systolic murmur

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39
Q

Triad of tricuspid regurg

A

Carvallo’s sign (louder with inspiration)
pulsatile JVD
pulsatle liver

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40
Q

Ventricular septal defect sound

A

harsh holosystolic murmur

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41
Q

Aortic stenosis sound

A

systolic crescendo-decrescendo

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42
Q

Hypertrophic cardiomyopathy sound

A

from dynamic obstruction
crescendo-decrescendo
louder with valsalva/standing/amyl nitrate

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43
Q

Major criteria for infective endocarditis

A 
\+ blood cultures (at least 2)
endothelial involvment (via echo/new regurg)
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44
Q

Minor criteria for IE

A 
predisposition
fever over 100.4
vascular phenomena
immuno phenomena
echo
microbiologic evidence (not proof)
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45
Q

Syncope cause with prolonged standing, emotional stress, or warm environment

A

neurocardiogenic syncope

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46
Q

Syncope with neck irritation and qualifiers

A

carotid sinus hypersensitivity
cardioinhibitory with pause over 3 sec
vasodepressor with decrease of 50mmHg without bradycardia

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47
Q

Syncope from cough, micturition, defecation, valsalva, deglutition

A

situational syncope

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48
Q

Syncope preceded by tongue/tonsillar pain

A

glossopharyngeal neuralgia

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49
Q

Cause of syncope with particular arm use

A

subclavian steal syndrome

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50
Q

Orthostatic hypotension numbers

A

over 20mmHg SBP or 10mmHg DBP change within 3 minutes of standing

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51
Q

Syncope with movement

A

atrial myxoma

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52
Q

Strept pyogenes lab identification

A

PYR +
bacitracin sensitive
beta hemolytic

53
Q

Blood labs for S. pyogenes

A

ASO titer

anti DNase B test

54
Q

Major Jones criteria for rheumatic fever

A 
Joint pain
Heart 
Nodules in sub q
Erythema marginatum
Syndeham's chorea
55
Q

Cause of Syndeham’s chorea in RF

A

cross rxn of antistrept Abs with basal ganglia

56
Q

Hypertrophy type with aortic stenosis

A

concentric

57
Q

Hypertrophy type with aortic regurg

A

eccentric

58
Q

Mitral regurg sound and things to increase

A

holosystolic blowing

squat/expiration

59
Q

Mitral stenosis sound

A

opening snap

diastolic rumble

60
Q

Peripheral indication of aortic regurg

A

parvus et tardus (slow rising pulse)

61
Q

Aortic regurg sound

A

early diastolic decrescendo

62
Q

Causes of wide S2 splitting

A

RBBB

pulmonic stenosis

63
Q

Aortic insufficiency sound and what increases sound

A

early diastolic decrescendo

increases with expiration/leaning forward

64
Q

Other murmurs assc with Aortic regurg

A

systolic ejection murmur

Austin Flint murmur (diastolic rumble)

65
Q

Signs assc with aortic regurg (7)

A

Duroziez sign- systolic cephalad, diastolic murmur caudad
Wide pulse pressure
Quincke’s pulse-phasic blanching of nails
Hill sign-popliteal over 60mmHg greater than brachial
Corrigan pulse-abrupt upstroke and fall of pulse
Traube sign-pistol shot sound over femoral
Mueller sign-pulsating uvula

66
Q

Cause of pulmonic regurg

A

pulmonary HTN or valve deformity

67
Q

Graham Steell murmur

A

assc with pulmonic regurg
early diastolic decrescendo murmur
high pitched
increases with inspiration

68
Q

Pulmonic insufficiency with valve deformity sound

A

mid diastolic crescendo-decrescendo

low pitched

69
Q

Mitral stenosis sound and way to increase sound

A

mid diastolic click with rumble

L lateral recumbent position

70
Q

Beck’s triad and what it indicates

A

hypotension
JVD
distant heart sounds
cardiac tamponade

71
Q

Exaggerated pulsus paradoxus

A

greater than 10mmHg between expiration and inspiration SBP

sign of cardiac tamponade

72
Q

Kussmaul sign

A

Increased JVD with inspiration

cardiac tamponade or constrictive pericarditis

73
Q

3 modes of echocardiography

A

M-Mode display (for thickness)
2D imaging
Doppler (for velocity/pressure changes)

74
Q

Pulsed vs continuous doppler echo

A

pulsed-senses low gradients, max 2m/s

continuous-high gradients

75
Q

Viral cause of dilated cardiomyopathy

A

echovirus

coxsackie B virus

76
Q

Dilated cardiomyopathy pathology cascade

A

myocyte degeneration
decreased CO
NE early and angiotensin II late to compensate
cause LV remodeling

77
Q

Major criteria for heart failure (6)

A 
paroxysmal noctural dyspnea
JVD
acute pulmonary edema
CVP>16cm H20
hepatojugular reflex
S3
78
Q

Tx for dilated cardiomyopathy

A

diuretics + ACE-I’s

metoprolol or carvedilol

79
Q

Benefit of digoxin with DCM

A

inhibits sympathetics (NE)

80
Q

Presentation of hypertrophic cardiomyopathy

A

dyspnea
angina
syncope

81
Q

Sound heart with HCM

A

S4

82
Q

Drug tx for HCM

A

beta blockers/CCB’s/disopyramide
amiodarone for arrhythmia
AVOID nidfedipine

83
Q

Primary and secondary cardiac amyloidosis

A

1-monoclonal light chain

2-fragments of serum amyloid A protein

84
Q

Cardiac amyloidosis appearance on echo

A

speckling

85
Q

Tx for aortic stenosis and possible increased risk

A

surgery is only definitive

increased risk with mitral regurg (doubles)

86
Q

Drugs for aortic regurg

A

nifedipine

87
Q

Aortic regurg surgery indication

A

LV ef less than 55%

Size >55mm systole, >75mm diastole

88
Q

Contraindications for acute aortic regurg

A

beta blockers

IABP

89
Q

Drugs for mitral stenosis

A

diuretics- for dyspnea
beta blockers- for Vent rate
anticoagulation

90
Q

Contraindications for percutaneous intervention of MS

A

extensive valve calcification

mitral regurg

91
Q

Chronic vs acute Mitral regurg

A

chronic-LA hypertrophy, decreased CO, fatigue

acute-normal LA, increased pulmonary venous P, pulmonary edema

92
Q

Acute mitral regurg drug tx

A

IV diuretics

IV vasodilators

93
Q

Chronic mitral regurg drug tx

A

vasodilators only if HTN present

94
Q

Another name for MVP

A

Barlow syndrome

95
Q

IMA use for CABG

A

LAD

96
Q

Graft closure rates

A

saphenous 50% open at 10 yrs

IMA 95% open at 10 yrs

97
Q

Post op risk of CABG and prophylaxis for it

A

A fib

beta blockers

98
Q

Tx for A. fib post CABG

A

beta blockers

anticoagulants past 48 hrs

99
Q

Benefits of mechanical valve replacement

A

last longer

but needs anticoagulants

100
Q

Benefits of bioprosthetic valve replacement

A

no need for anticoagulants

replaced after 10-15 yrs

101
Q

Greater demo benefited by multivalve surgery

A

elderly and high risk pts

102
Q

Acute pericarditis tx for viral

A

NSAIDS

corticosteroids/colchicine for refractory

103
Q

Acute pericarditis post MI caution

A

avoid corticosteroids/NSAIDS

use ASA

104
Q

Ewart’s sign

A

dullness to percussion over angle of L scapula

sign of pericardial effusion

105
Q

Pericardial effusion and EKG

A

low voltage

electrical alternans

106
Q

Ventricular interdependence and pericardial effusion

A

Bulging of septum into LV causes decreased CO with pericardial effusion (during inspiration)
Causes exaggerated pulsus paradoxus

107
Q

Cardiac cath finding in both pericardial effusion and constrictive pericarditis

A

equal diastolic P in all chambers of heart

108
Q

Pericardial knock

A

early diastolic sound from abrupt cessation of ventricular filling

109
Q

Constrictive pericarditis and pulsus paradoxus

A

not present

but increases JVD with inspiration

110
Q

Constrictive pericarditis and cardiac cath finding

A

dip and plateau in diastole of both ventricles

111
Q

Causes of pericardial effusion beside pericarditis

A

cardiac rupture

myxedema

112
Q

Cardiac tamponade sx

A

Beck’s triad: hypotension, JVD, distant heart sound
dyspnea
diaphoresis
pericardial pain

113
Q

Cardiac tamponade signs on EKG

A

low voltage

electrical alternans

114
Q

Cause of primary pericarditis

A

viral origin

115
Q

Causes of secondary pericarditis

A

metastasis
cardiac disease
surgical procedure

116
Q

Serous pericarditis cause and histo finding

A

noninfectious: autoimmune, tumors, uremia

epipdercardial fat

117
Q

Fibrinous/serofibrinous pericarditis

A

sandy heart surface (bread and butter)
fibrinous exudate
seen in MI

118
Q

Purulent/suppurative pericarditis

A

due to infection (pneumonia/lymphatic/hematoginous spread)
creamy, yellow exudate
causes scarring

119
Q

Hemorrhage pericarditis

A

commonly caused by metastases
also TB caused
blood in pericardium

120
Q

Caseous pericarditis

A

TB, TB and more TB

absolutely no JBeebs

121
Q

Chronic/healed pericarditis

A

fibrous thickening
stringy adhesions
no impact on fxn

122
Q

Adhesive mediastinopericarditis

A

adherence of outer pericardium to mediastinal structures

increases stress/workload of heart

123
Q

Constrictive pericarditis

A

visceral/parietal fusion (dense)
cannot increase CO
TB/radiation/surgery/metastasis caused
wt loss/fatigue/edema

124
Q

Rheumatoid arthritis on the heart

A

serous or fibrinous pericarditis

125
Q

Acute Rheumatic fever

A

group A strep

pharyngitis -> RF -> chronic heart disease

126
Q

Acute RF histo

A

Aschoff bodies with Antischkow myocytes (long thin nucleus)

127
Q

Rheumatic MVP

A

commissural fusion/fish mouth look

thick/short chordae tendineae

128
Q

Chronic RF valve disease histo and impact on valve

A

lymphocytes

extensive calcification

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